The Department of Industrial Accidents (DIA) oversees all disputes involving injured workers in the Commonwealth and is governed by M.G.L. c. 152 and 452 CMR § 1.00 – 9.00. The DIA acts as a dispute resolution system.

The PWOP is the first 180 days of disability. It is during this period that the Workers’ Compensation insurer can pay a claim without accepting liability for that injury. This means the insurer can terminate benefits for any reason within that period so long as they give seven days’ notice.

Call a lawyer to determine what next steps need to be taken. If you are still treating and unable to work, reach out to your doctor and get an updated disability note. Your lawyer will need to file a claim with the DIA with the updated disability note.

Your case is scheduled for a Conciliation. Conciliation is the initial step in the litigation process, and it is determined at this level if the moving party has sufficient documentation to support the claim.

Sufficient documentation is a medical opinion supporting disability due to a work injury or need for medical treatment due to a work injury.

No. Your attorney attends the Conciliation on your behalf.

Your case is scheduled for a Conference. This is a proceeding before an Administrative Judge at the DIA.

Yes. Although the Conferences are done virtually you still must be “virtually” present. Be sure to discuss how to log into a Conference with your Attorney in advance or go to their office and sit with them.

No. There is no testimony taken at the Conference. It is an informal proceeding with presentations presented by the attorneys.

The proceeding is allotted 30 minutes, but most Conferences are approximately 15-20 minutes.

The Judge publishes a Conference Order. This Order will specify what benefits are awarded, if any.

Yes. The Workers’ Compensation insurer still has to pay pursuant to the order even if it is appealed. The insurer has 14 days from the date of the order to issue payment.

In most cases, the injured worker is scheduled for a state impartial examination with a state appointed doctor.

The state doctor is supposed to provide the Administrative Judge with an impartial opinion as to issues disputed by the parties. These issues include disability, causation, treatment, etc.

Talk to your lawyer. There are arguments a lawyer can make to allow the Judge to consider other medical opinions in addition to the impartial physician.

Your case will be scheduled for a Hearing.

At the Hearing you will testify regarding your injury, treatment, disability, etc.

Settlement is not a guarantee in Workers’ Compensation cases as it is a wage replacement system. Thus, while most cases do settle, it may not be appropriate in your case. All cases are different and if your case is suitable for settlement, it can happen at any time in the litigation process.

Again, all cases are different. There isn’t a set value a case settles for. There are several different factors that are considered. These factors are your wage, education, vocational background, extent of injury, treatment, the impartial doctor’s opinion, etc. Talk to your lawyer if you have questions regarding settlement.

Settlement with liability means the Workers’ Compensation insurer is accepting responsibility for your work injury thereby accepting medical treatment that is reasonable, necessary and related to the work injury. Settlement without liability means the Workers’ Compensation insurer is not accepting responsibility for your work injury and thereby not responsible for paying for medical treatment.

Your attorney will draft paperwork with the insurer and arrange for a Lump Sum Conference with an Administrative Judge.

The Administrative Judge reviews the settlement and determines if the settlement is in your best interest. The Judge also goes over with you what the settlement means for you and what rights, if any, remain open.

You will be given insurance information by the Workers’ Compensation insurer when injured. This will include a claim number, adjuster contact, etc. Provide this information to your doctor or the medical facility and they will reach out to the insurer to get approval to treat you.

Call a lawyer. A Claim for medical treatment can be filed with the Department of Industrial Accidents.

A Form 105 is an agreement to extend the pay without prejudice period. Do not sign this agreement without speaking with your lawyer. The insurer may present this agreement as being a good thing, but it can negatively impact your case in the future.

Nurse case managers are being paid by the insurance company to help manage the medical treatment you receive. This can have a negative impact as they often times can pressure your treating physician to provide opinions as to your work capacity or regarding medical treatment that is being recommended. It is best to talk to your lawyer about how to handle nurse case managers and if one is appropriate in your case.

No. When someone applies for unemployment benefits, they hold themselves out as being willing, ready and able to work. This is a contradiction if you are applying for total disability benefits under the workers’ compensation statute.